Trump laid the groundwork for rolling back the mandate early this month when he signed an executive order directing his administration “to address conscience-based objections” to preventive care for women.
Photograph: Alamy

The Trump administration has drafted a federal rule that would allow many religious employers to stop providing contraception coverage in company healthcare plans, the result of a “religious freedom” executive order signed by Donald Trump earlier this month.

The rule, as first reported by the New York Times, would overturn one of the most controversial policies to result from the Affordable Care Act: a mandate for most employers to provide birth control coverage at no additional cost to their workers.

The text of the rule, which is in the “interim final” stage, is not yet publicly available. But it could take effect as soon as the administration chooses to publish the rule in the federal register.=

The so-called contraception mandate, which the Obama administration adopted as part of its enforcement of the healthcare law, was the target of dozens of lawsuits by employers who claimed that it violated their religious beliefs.

Trump laid the groundwork for rolling back the mandate early this month when he signed an executive order directing his administration “to address conscience-based objections” to preventive care for women.

The Little Sisters of the Poor led scores of religious employers in suing over the contraception mandate.

Under the ACA, popularly known as Obamacare, the Obama administration made it a requirement for employee healthcare plans to offer coverage for a range of contraceptive devices and services.

However, the administration offered an exemption for employers with a religious mission who opposed contraception on moral grounds. To claim that exemption, an organization simply had to notify the health department that it would not cover contraception.

Yet many religious groups objected to even notifying the government that they didn’t intend to cover contraceptives. In a legal battle before the supreme court, the Little Sisters of the Poor argued that notifying the government was tantamount to providing contraception coverage, because the government would act on that notification to make alternate arrangements for coverage.

The court declined to rule on the principles at the heart of the case and instead directed the government and the Little Sisters to reach a compromise.

The contraception mandate took effect in August 2012. While it is not clear how many women gained contraception coverage as a result, the mandate is responsible for a sharp drop in out-of-pocket spending on contraception. A recent, nonpartisan poll found that a majority of women would struggle to afford birth control with a copay.

Early research has also associated the contraception mandate with a historic drop in the US abortion rate that occurred in 2014.

Trump and top members of his administration have long sworn to do away with the mandate. It was one of the first promises Mike Pence made as vice-president-elect. And Tom Price, the head of the health department, is hostile to the idea that some women require assistance to pay for birth control, once challenging a reporter to “bring me one woman” who struggled to afford contraception.

The Trump administration has not clarified whether it will allow the typical period for public comment before it publishes its draft rule.

The ACA prohibits discrimination in the healthcare market based on gender, one possible reason that reproductive rights advocates could block the rule in court.